NPIMap

Organization Active NPI

Ki Lee Dental Corp.

  • General Practice Dentistry
  • Cerritos, CA
National Provider Identifier
1699452821
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KI LEE DENTAL CORP.
Doing business as
K-Smile Dentall
Ki Baek Lee DDS
Ki Lee Dental Corp.
Practice address
11900 South St Ste 122
Cerritos, CA 90703-6800
Phone
(562) 809-6177
Fax
(562) 809-7659
NPI assigned
Jun 29, 2023
Organization subpart
Yes
Parent organization
KI BAEK LEE DDS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ki Baek Lee, DDSNPI 1396054011
Title
Dentist
Phone
(323) 880-3704

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

11900 South St Ste 122
Cerritos, CA 90703-6800

Mailing address

11900 South St Ste 122
Cerritos, CA 90703-6800
Phone (562) 809-6177

Other practice location 1

6501 Eastern Ave Ste B
Bell Gardens, CA 90201-3003
Phone (323) 773-2082

Other identifiers 1

IdentifierTypeStateIssuer
1508373002MedicaidCA

Other names 3

  • K-Smile Dentall Doing business as
  • Ki Baek Lee DDS Doing business as
  • Ki Lee Dental Corp. Doing business as

National Provider Directory

National Provider Directory
Part of
Ki Lee Dental Corp

Locations

6501 Eastern Ave
#B
Bell Gardens, CA 90201
Phone (323) 773-2082

11900 South St
Ste 122
Cerritos, CA 90703
Phone (562) 809-6177

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1699452821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 SOUTH ST STE 122",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036800",
            "telephone_number": "562-809-6177",
            "fax_number": "562-809-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 SOUTH ST STE 122",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036800",
            "telephone_number": "562-809-6177",
            "fax_number": "562-809-7659"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6501 Eastern Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Bell Gardens",
            "state": "CA",
            "postal_code": "902013003",
            "country_code": "US",
            "telephone_number": "323-773-2082",
            "fax_number": "323-560-3905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KI LEE DENTAL CORP.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KI BAEK LEE DDS INC",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KI",
        "authorized_official_middle_name": "BAEK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "323-880-3704",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508373002",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "K-Smile Dentall",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ki Baek Lee DDS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ki Lee Dental Corp.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cerritos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.